Emergency Medicine Journal最新文献

{"title":"A survey of major incident preparedness in English type 1 emergency departments.","authors":"Adrian A Boyle, Atasi Bhattacharjee","doi":"10.1136/emermed-2024-214843","DOIUrl":"https://doi.org/10.1136/emermed-2024-214843","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the impact of self-rostering on EM trainee wellbeing and recovery: a national survey.","authors":"Alexander Robertson","doi":"10.1136/emermed-2024-214642","DOIUrl":"https://doi.org/10.1136/emermed-2024-214642","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid cycle QI methods ensure prompt paediatric emergency care during 2022 respiratory surge.","authors":"Alexandria Wiersma, Anthony Watkins, Traci Ertle, Bernadette Johnson, Sandra Spencer","doi":"10.1136/emermed-2024-214180","DOIUrl":"https://doi.org/10.1136/emermed-2024-214180","url":null,"abstract":"<p><strong>Objectives: </strong>In fall 2022, paediatric EDs (PEDs) and urgent cares (PUCs) cared for an unprecedented number of children, leading to long waits and boarding patients. This surge mimicked the adult ED/UC COVID-19 pandemic experience. Learning from published data and surge response plans, we adapted our response using rapid cycle quality improvement methodology.</p><p><strong>Methods: </strong>A multidisciplinary PUC/PED team met to determine the current state and create interventions. After the standard seasonal surge response did not have a significant impact, we further expanded inpatient capacity, created new physical PUC space, started provider intake and transitioned PED beds to inpatient.</p><p><strong>Results: </strong>Statistical control charts were used to monitor metrics from 4 weeks prior to the surge to when volumes returned to baseline, but improvement was seen prior to this. Our primary outcome measure, left without being seen (LWBS) rates, decreased from a peak of 40% to <5% and PUC door-to-provider time (process measure) decreased from 158 min to 106 min before the surge was over. These metrics also dropped below the prior baseline after volumes returned to normal. PED door-to-provider time (process measure) and PUC lengths of stay (LOS) (balancing measure) were maintained throughout.</p><p><strong>Conclusions: </strong>Using rapid cycle methodology, we responded quickly to an unprecedented patient volume by innovatively increasing staffing and space. We improved LWBS rates and PUC door-to-provider time despite high volumes and large numbers of boarding patients. We created efficiencies that allowed us to maintain PUC LOS and PED door-to-provider times during the surge. This resulted in sustained improvement, and we now operate with shorter LOS and door-to-provider times than historically achieved.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in paramedic-to-general practitioner referrals following the COVID-19 pandemic and the introduction of a virtual emergency department: an interrupted time series analysis.","authors":"Belinda Jane Delardes, Ziad Nehme, Kelly-Ann Bowles, Samantha Chakraborty, Emily Mahony, Karen Smith, Jason Talevski, Loren Sher, Emily Nehme","doi":"10.1136/emermed-2024-214561","DOIUrl":"https://doi.org/10.1136/emermed-2024-214561","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the impact of the COVID-19 pandemic and subsequent introduction of the Victorian Virtual Emergency Department (VVED) consultation service for paramedics on paramedic-to-general practitioner (GP) referral patterns, case time burden and ambulance reattendance rates.</p><p><strong>Methods: </strong>We conducted interrupted time series regression assessing paramedic-to-GP referrals with the following two interruptions: (1) the COVID-19 pandemic in March 2020 and (2) VVED integration in July 2022. We included ambulance patients between 2018 and 2023 across Victoria, Australia.</p><p><strong>Results: </strong>A total 3 205 562 patients across 65 months were included; 38.7% presented in the 26 months prior to the beginning of the COVID-19 pandemic (n=1 239 975), 43.8% between March 2020 and June 2022 (n=1 403 139) and 17.6% in the 11 months after VVED implementation (n=562 448). There was no step change in paramedic-to-GP referrals associated with the COVID-19 pandemic, although a 3% relative monthly trend increase in referrals to GP occurred (incident rate ratio (IRR) 1.03, 95% CI 1.02 to 1.04). Subsequent VVED integration was associated with a -16% relative step change in referrals to GPs (IRR 0.84, 95% CI 0.74 to 0.96); however, no trend change was observed. Median case time burden increased throughout the study by 0.52 min per month (median difference 0.52 min, 95% CI 0.51 to 0.52). At the study period conclusion, EMS attendances resulting in GP referrals had a 40 min median case cycle duration, compared with 120 min for ED conveyances. Ambulance 7-day reattendance rates were similar between those referred to VVED (8.8%) vs GPs (8.7%).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was associated with increased paramedic-to-GP referrals in lieu of ambulance conveyances. The VVED was associated with an initial decrease in paramedic-to-GP referrals; however, the trend of increasing GP referrals continued. paramedic-to-GP referrals consumed a third of the time burden associated with ambulance conveyance to ED.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled or nebulised salbutamol for exacerbations of asthma and chronic obstructive pulmonary disease?","authors":"Ame Kumba Saidy, Bethany Foo","doi":"10.1136/emermed-2024-214699","DOIUrl":"https://doi.org/10.1136/emermed-2024-214699","url":null,"abstract":"<p><p>A short review of the literature was conducted to compare the length of emergency department (ED) stay and hospital admission rates in patients with exacerbations of asthma or chronic obstructive pulmonary disease (COPD) treated with salbutamol via a metered dose inhaler with a spacer (MDIS) versus nebulisation. Database searches were conducted using Cochrane, EMBASE, MEDLINE and Google Scholar. Six papers met our inclusion criteria and underwent analysis. Our results suggest that delivery of salbutamol via MDIS may reduce hospital admissions and ED length of stay in this patient cohort.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of tongue coating in identifying acute appendicitis: a prospective cohort study.","authors":"Hideki Mori, Kazumi Yamasaki, Yusuke Saishoji, Yuichi Torisu, Takahiro Mori, Yuki Nagai, Yasumori Izumi","doi":"10.1136/emermed-2024-214210","DOIUrl":"https://doi.org/10.1136/emermed-2024-214210","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis requires timely diagnosis. The diagnostic efficacy of tongue examination in making this diagnosis has not been established. This study investigates whether the Tongue Coating Index (TCI), a validated measure of tongue coating, can aid in diagnosing acute appendicitis.</p><p><strong>Methods: </strong>We conducted a prospective cohort study (1 September 2018-31 December 2020) at a single Japanese hospital. Adults (≥20 years) with suspected acute appendicitis, presenting to either the emergency department or general outpatient clinic, were enrolled. Tongue images were taken at presentation; two independent examiners-unrelated to clinical care and blinded to patient data-later scored these images using the TCI. A composite reference standard (clinical findings, imaging, histopathology, follow-up) was used to confirm appendicitis. We compared the TCI's diagnostic performance with the Alvarado score and its components using C-index, area under the curve (AUC), sensitivity and specificity.</p><p><strong>Results: </strong>Of 145 included patients, 69 (47.6%) were diagnosed with acute appendicitis. The TCI demonstrated comparable discriminative ability (C-index AUC 0.62; 95% CI, 0.53 to 0.71) to that of the Alvarado score (0.66; 95% CI, 0.57 to 0.75). Of Alvarado score components, migration of pain had an AUC of 0.63 (95% CI, 0.55 to 0.71), anorexia 0.58 (95% CI, 0.50 to 0.66) and tenderness in the right lower quadrant 0.55 (95% CI, 0.50 to 0.60). At a cut-off of 3, the TCI demonstrated high sensitivity of 96% (95% CI, 88% to 98%) but low specificity of 21% (95% CI, 13% to 32%). Conversely, at a cut-off of 10, the TCI showed increased specificity of 83% (95% CI, 73% to 90%) but reduced sensitivity of 29% (95% CI, 20% to 41%).</p><p><strong>Conclusion: </strong>The TCI showed comparable diagnostic performance to the Alvarado score and its individual components. TCI may potentially serve as an additional non-invasive indicator for diagnosing or ruling out acute appendicitis. Further research is essential to validate its clinical utility.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global health experience of staff working in UK emergency care: a reflexive thematic analysis.","authors":"Silas Webb, Charlotte Ward, Claire Crichton-Iannone, Alexandra Taylor, Anisa Jabeen Nasir Jafar","doi":"10.1136/emermed-2023-213823","DOIUrl":"https://doi.org/10.1136/emermed-2023-213823","url":null,"abstract":"<p><strong>Background and aims: </strong>There is growing recognition among practitioners worldwide of the benefits of practising emergency medicine in different countries and healthcare settings. A recent survey by the Royal College of Emergency Medicine found interest and experience in global health (GH) work among college members, but many struggled with barriers that limited their contribution to this work. This study aims to understand the role of GH experience by emergency care practitioners and how it interconnects with the National Health Service and UK practice.</p><p><strong>Methods: </strong>Anonymised semistructured interviews were conducted from August to November 2022 on a purposive sample of UK emergency care practitioners who had previously undertaken GH work. Reflexive thematic analysis was used to analyse and present their experiences in this field.</p><p><strong>Results: </strong>The three key themes from the analysis were that emergency care is a specialty well positioned to contribute to GH settings; practitioners feel this contribution confers benefits to both the individual and their healthcare system; and the current structure of UK emergency care training presents barriers to maximising the benefits of these experiences.</p><p><strong>Conclusion: </strong>The perceived benefits of GH involvement to the emergency care and base organisation are manifold; as are the skills offered by this practitioner group. Readily accessible funding, networks, mentorship and support from training programme leadership were all identified as ways of improving the quality and frequency of meaningful GH involvement.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic brain injuries in civilian war victims in Afghanistan.","authors":"Ornella Spagnolello, Silvia Fabris, Shekiba Esmati, Arezo Dost, Muhebullah Ahmadzai, Ahmad Khan Aryan, Sofia Gatti, Manuela Cormio, Gina Portella, Martina Baiardo Redaelli","doi":"10.1136/emermed-2024-214127","DOIUrl":"10.1136/emermed-2024-214127","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injuries (TBIs) are a common cause of morbidity and mortality in war zones. Currently, the vast majority of reports on war-related TBIs concern soldiers, and little is known about this condition in civilians.</p><p><strong>Methods: </strong>This is a retrospective observational study from the EMERGENCY NGO hospital for civilian war victims in Kabul, Afghanistan. Data were gathered for all adults and children with war-related TBIs admitted between June and November 2021. The study aims to describe the epidemiology and clinical patterns of patients with war-related TBIs in a non-military context.</p><p><strong>Results: </strong>Out of a total of 1469 hospital admissions during the study period, 130 (8.8%) were war-related TBIs. Among these, 90 (69.2%) involved a penetrating brain injury. More than one-third of the study population were children aged 14 or younger (36.1%), and the most frequent cause of war-related TBIs was shells (58.1%). The median time from injury to admission was 3 hours (from 30 min to 3 days), with only 19% of patients presenting in the 'golden hour'. Neurosurgery was performed on 38 patients (29.2%), and 55 patients (42.3%) underwent mechanical ventilation. In-hospital mortality occurred in 35 patients (26.9%), including 15 do-not-resuscitate cases.</p><p><strong>Conclusions: </strong>War-related TBIs were frequent among adults and children and had a high mortality rate. With more than one-third of patients undergoing mechanical ventilation, our data highlight that the availability of intensive care units with the ability to ventilate patients is of the utmost importance to save lives of civilians in areas of armed conflict.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"231-236"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best possible care in the circumstances.","authors":"Simon Horne","doi":"10.1136/emermed-2025-214860","DOIUrl":"10.1136/emermed-2025-214860","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"273-274"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The journey to the front door; what pathways do paediatric patients take prior to attending the emergency department?","authors":"Laura Gabbott, Holly Shaw, Thomas Munro, Ellie Burke, Chloe Yeabin Jung, Ottalie Hoskyns, Oriana Munden, Michael Malley","doi":"10.1136/emermed-2024-214220","DOIUrl":"10.1136/emermed-2024-214220","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"241-242"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}